Underage Drinking Linked to Breast Disease Risk

Action Points

Note that the AAP recommends regularly screening of adolescents and young adults for alcohol and other drug use.

Inform interested patients that even moderate alcohol intake in women has been linked in previous studies to risk of breast cancer, an association that may bear similarity to the increased risk of benign breast disease in young women who drink.

Underage alcohol use may boost risk of benign breast disease at an early age, according to a prospective study released along with American Academy of Pediatrics statement urging pediatricians to fight adolescent drinking.

Data from almost 7,000 young women revealed a 50% increased risk of biopsy-confirmed benign breast disease with every additional drink a girl typically consumed per day at age 15 to 22 (95% confidence interval 19% to 90%).

Those who drank almost every day were at 5.5-fold risk (95% CI 1.23 to 24.53) compared with those who drank less than once a week or never drank, Catherine S. Berkey, ScD, of Harvard's Channing Laboratory in Boston, and colleagues reported online in Pediatrics.

The risk of benign breast disease comes on top of increasing evidence that alcohol interferes with the brain development that continues into early adulthood, Berkey and colleagues wrote.

They analyzed the Growing Up Today Study, a prospective cohort study of American girls whose mothers participated in the Nurses Health Study II and which included a survey about consumption of alcohol in the prior year when the daughters were age 15 to 22.

At age 18 to 27, 147 of the 6,899 women reported that a health care provider had ever diagnosed them with benign breast disease. Sixty-seven reported that this diagnosis had been confirmed by biopsy.

Adjusted for age and body mass index, those who drank once or twice a week had a nonsignificant 72% elevated risk of benign breast disease compared with girls who drank never or less than weekly.

Those who drank three to five days a week had 3.34-fold risk (95% CI 1.28 to 8.74).

The risk was seen in every BMI group and were not explained away by analyses incorporating age at menarche, maternal breast cancer or biopsy-confirmed benign breast disease, or age at onset of regular drinking.

These findings raise concern since benign breast disease portends later breast cancer and drinking is a known risk factor for breast cancer among adults, they said.

"If future work confirms our findings, then clinician efforts to delay the onset of alcohol consumption and to reduce amounts consumed may prevent some cases of benign breast disease and breast cancer," they wrote in Pediatrics.

Efforts to counteract alcohol and other substance use by adolescents should start early -- even at prenatal visits -- recommended the AAP committee led by Patricia K. Kokotailo, MD, MPH, of the University of Wisconsin in Madison.

Pediatricians should include alcohol and other substance use in the medical and social history taken at prenatal and health supervision visits, they wrote.

Regular screening for current alcohol and other drug use should be done throughout the adolescent and young adult years "using nonjudgemental, validated screening methods and appropriate confidentiality assurances," according to the statement.

Early initiation of drinking is also associated with greater lifetime risk of alcoholism, more sexual risk-taking, academic problems, as well as later difficulties with employment, other substance abuse, and criminal and violent behavior, it noted.

The still-maturing adolescent brain is particularly vulnerable to the reduced functioning of the prefrontal cortex and decrease in dopamine 2 receptors induced by alcohol withdrawal, they noted.

Studies have suggested that those who use alcohol starting in the adolescent years use fewer strategies to learn new information and lose memory skills along with reduced hippocampal volumes and subtle white-matter abnormalities.

For pediatric patients found to be using alcohol, brief intervention techniques in the clinical setting, such as motivational interviewing, may help for those who don't meet criteria for immediate referral, according to the statement.

It recommended that pediatricians become familiar with local resources to which they can refer patients with alcohol use disorders, their parents, and other family members for "developmentally-appropriate treatment."

Berkey's study was funded by the Breast Cancer Research Foundation and the National Institutes of Health. The researchers reported no conflicts of interest.

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